Atherosclerotic renal artery Stenosis (ARAS) is a far more common problem in India that thought.It is concluded that about 0.8% of Indian urban population has significant Atherosclerotic Renal artery stenosis.Its been long argued which therapeutic modality is the best for the treatment of ARAS.After few randomized trials its being concluded that Medical therapy(Renin Angiotensin Aldosterone System ) is the best therapy for the treatment of ARAS.
Why renal artery stenting doesn't work in ARAS?
1.ARAS not only involves Renal artery but also intrarenal artery ,arterioles and peritubular capillaries. Stenting will not have any effect on Intrarenal Atherosclerotic Renal Vascular Disease(ARVD)
2.ARAS protects the kidney from the ill effects of hypertension as the flow beyond the obstruction or stenosis is decreased. Stenting removes the stenosis or obstruction and kidney is exposed to high bp.
3.Stenting may cause distal atheroembolism,dissection of renal artery and cholesterol embolism that might accelerate the renal damage.
In summary, published RCT provide no support for the notion that renal angioplasty with stenting improves blood pressure, preserves renal function or, reduces episodes of congestive heart failure in patients with ARAS. RA stenting is associated with procedure related morbidity and mortality. Agents that block RAAS improve outcomes and should be a part of the medical regimen in ARAS.Medical therapy effectively controls ARVD at all levels of the vasculature and hence is the best therapy for ARAS.
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